Impact of Federal Health IT Priorities on FHA Strategic Plan Gretchen Wyatt, ONC Dr. Lauren Thompson, Director, FHA

Agenda Federal Health IT Priorities Impact of Federal Health IT Priorities on FHA’s Strategic Plan

Gretchen Wyatt Office of the National Coordinator for Health IT FEDERAL HEALTH IT PRIORITIES

FHA Strategic Plan – Vision A Federal health information technology environment that is interoperable with the private sector and supports the President’s health information technology plan enabling better care, increased efficiency, and improved population health

Federal Health Architecture: Advancing National Health IT FHA Guiding Principles Stakeholder Engagement Demonstrate through Pilots Open Communication and Transparency Commitment to Action Focus on Specifications FHA Moving Forward: 2014 STRATEGIC GOALS Establish a unified federal voice on health data exchange and interoperability Establish FHA as a “convener of stature”, and broaden participation Institutionalize governance decision-making processes Expand outreach and access to tools Achieve adoption of interoperability specifications, leading to active data exchange in the Federal health community Support S&I Framework by providing federal use cases and pilots Enable FHA partners to move from legacy to new solutions in effective, coordinated manner Align federal policies in healthcare data exchange Provide a forum of cataloging and aligning federal policies and practices

Impact of Federal Health IT Priorities FHA Strategic Plan grows and evolves to support federal health IT priorities FHA federal partners contribute to development of priorities, ensure addition of federal requirements FHA encourages federal agencies to adopt priorities to their unique health IT requirements

Current FHA Health IT Priorities Healthcare Directory Patient Consent & Authorization Directed Exchange CONNECT Federal Health Information Model (FHIM) Integrating with the Standards and Interoperability Framework Patient Identification This is an ONC priority that FHA supports.

CONNECT Open Source Community Development CONNECT is moving to the open source community for management FHA will remain engaged to ensure developments include federal requirements Join the CONNECT Open Community Collaboration today: http://www.connectopensource.org/developer-resources/forums

Engagement in the Standards & Interoperability (S&I) Framework FHIM S&I Requirements Scope Modeling Data Collection Publish Discovery Pre-Discovery Pilot Implementation Evaluation Support for Federal partner priorities such as Meaningful Use Direct support of Federal partner use cases FHIM provides semantic and syntactic modeling constructs to support the definition of information FHIM, combined with MDHT*, can be used to generate implementation standards using an MDA* approach *MDHT - Model Driven Health Tools *MDA - Model Driven Architecture

Core workgroups that support federal health IT priorities: FHA Workgroups Core workgroups that support federal health IT priorities: Architecture & Modeling Data Exchange & Interoperability Communications & Coordination Directed Exchange

Stay connected, communicate and collaborate Find out more about FHA on the ONC website: http://www.healthit.gov/FHA Contact us at: federal.health@hhs.gov Subscribe, watch, and share: @ONC_FHA, @CONNECT_Project http://www.flickr.com/photos/federalhealtharchitecture/

Applying RESTful Health Exchange, FHIR, and Direct ONC Annual Meeting Ollie Gray (TATRC) 24 January 2014

Outline RESTful Health Exchange RESTful Health Exchange Addresses Gaps Research, Development, Testing and Evaluation (RDT&E) with REST and Direct RDT&E Outcomes Summary

RESTful Health Exchange Open source project to apply Web technologies to demonstrate a simple, secure, standards-based health information exchange Builds the foundation for patient access to data via the Web and mobile devices, facilitating broad electronic health data exchange Offers a new approach to health data exchange: Replaces moving documents to linking to needed information Sponsored by the Federal Health Architecture (FHA) program in FY12, TATRC in FY13 and FY14, VHA in FY14 Addresses NwHIN Power Team recommendation to develop a specification for RESTful exchange of health data Applies RESTful health data exchange to key capability gaps VHA=Veterans Health Administration NwHIN=Nationwide Health Information Network http://wiki.siframework.org/RHEx REST technology enables secure, Web-based health data exchange

RESTful Health Exchange Addresses Gaps SMTP (Direct) does not scale to allow sharing of very large files, such as diagnostic images Lightweight exchange is needed to allow health information sharing with out-of-network providers Standing up CONNECT can be a challenge for small, independent providers and providers in rural areas CONNECT capabilities not needed for stateless transactions

Research, Development, Testing and Evaluation (RDT&E) with REST and Direct Improved Coordination of Care ~ Timely Remote Record Access ~ Low barrier of entry

REST with Direct for Sharing Diagnostic Images Demonstrated in a RDT&E environment that MHS and third-party providers can access diagnostic images and associated records securely over the Web MHS = Military Health System PCM = Primary Care Manager Improved Coordination of Care ~ Timely Remote Record Access

RDT&E Outcomes RDT&E initiatives successfully demonstrated that: Physicians can securely share health data over the Web Diagnostic images can be shared using REST with Direct High volumes of data can be moved over the Web securely in support of HIE patient data integration RESTful capability is being implemented across Maine to support small, independent providers and FQHCs in medically underserved areas New Pilot with TATRC in FY14 REST and FHIR technology being explored as possible solutions for government HIE exchanges New pilot with VHA Office of Rural Health (ORH) REST, FHIR, and Direct technology will support secure sharing of information between VHA and third-party providers in support of home healthcare for Veterans in rural Utah FQHC = Federally Qualified Health Center iEHR = integrated Electronic Health Record

Summary RDT&E initiatives with REST and Direct have addressed gaps in capability Out-of-network providers can share information securely over the Web using REST Direct + REST can be used to share diagnostic images in a scalable fashion REST can be used to allow small, independent providers and providers in rural areas to exchange health information RDT&E initiatives contributed to the goals of: Improved care coordination Equal healthcare for all Timely remote record access Low barrier-of-entry for small practices Applicability of FHIR is being explored Goals map to :http://www.himss.org/ValueSuite

Federal PKI Cross-Certifictation Overview 24 January 2014 Deb Gallagher, GSA FPKIPA Chair ONC Annual Meeting Federal Priorities for Health IT Training Session

Work Groups and Tiger Teams Agenda FPKI Overview FPKI Cross-Certification Process Cross-Certified Affiliates PIV-I Providers EGCA Overview and Purpose Work Groups and Tiger Teams

Criticality of PKI Consumer Online Shopping and Banking CAC Card Access to Systems and Facilities Trusted B2B, G2B, C2B, C2G Communications PIV Card Access to Trusted Network Devices and VPN Signed Code for Trusted Execution Public Key Infrastructure Government Trusted by Commercial Organizations Commercial Organizations Trusted by Government Policies and Governance Trusted Issuers Trusted Algorithms Revocation and Validation PKI Enables PKI Trust Components PKI provides identity authentication, integrity, confidentiality Formal controls for certificate issuance and management enable trust in these services

FPKI Purpose The FPKI facilitates federated identity Throughout the Federal Government; and Between the Federal Government and external partners Includes the FPKI Trust Infrastructure Federal Bridge Certificate Authority (FBCA) Cross-certification assures comparability of certificate issuance policies Incorporates multiple assurance levels Federal Common Policy CA (FCPCA) Trust Anchor for the U.S. Federal Government E-Governance CAs (EGCA) Supports various ICAM Programs The FPKI Policy Authority (FPKIPA) governs policies for operation of the FBCA, FCPCA, and EGCA Operates under the authority of the Federal CIO Council

Cross-Certification Process Overview

Currently Cross-Certified Affiliates Federal Agencies Department of Defense (DoD); Department of State (DoS); Drug Enforcement Administration (DEA CSOS); Government Printing Office (GPO); Department of Treasury; United States Postal Service (USPS); and United States Patent and Trademark Office (USPTO) Two PKI Bridges CertiPath:* Aerospace and Defense Eid Passport* Cassidian* Carillion* Non-Federal PKIs State of Illinois Entrust* Verizon Business* Symantec* ACES – ORC & Identrust DoD ECAs DigiCert* ORC* Identrust Exostar SAFE-BioPharma: Pharmaceutical and healthcare industries = PIV-I Provider

EGCA – Supports ICAM The EGCA supports the ICAM mission by: Enabling governance – control which endpoints participate and can be trusted for technical interoperability or information sharing. Conveying trust between endpoints in a transaction – allow endpoints to determine trust at run time. Facilitating secure communications between endpoints in a transaction – once endpoints have established trust, the ensuing communication between endpoints is secure. The EGCA supports ICAM Assertion-based Initiatives Issues certificates to devices and applications. Issues different types of certificates to different types of endpoints. Enables trusted access to government services for more participants and communities of interest (e.g., commercial and financial communities).

Questions? Q&A ??? Deb Gallagher General Services Administration Office of Governmentwide Policy Director, Identity Assurance and Trusted Access Division 202.219.1627 (desk) 202.604.5733 (mobile) Deborah.Gallagher@gsa.gov